Easing Arthritis Hand Pain

 

Help for Hand Arthritis - Transcript

PODCAST OPEN:      

You’re listening to the Live Yes! With Arthritis podcast, created by the Arthritis Foundation to help people with arthritis — and the people who love them — live their best lives. This podcast and other life-changing resources are made possible by gifts from donors like you. If you’re dealing with chronic pain, this podcast is for you. You may have arthritis, but it doesn’t have you. Here, learn how you can take control of arthritis with tips and ideas from our hosts and guest experts.

         

This episode of the Live Yes! With Arthritis podcast is brought to you in part by Aleve, proud partner of the Arthritis Foundation.

 

MUSIC BRIDGE

 

Trina Wilcox:

Welcome to the Live Yes! With Arthritis podcast. My name is Trina Wilcox, your host for this episode. Now, I was diagnosed as a kid — 6 years old is when they finally got it all figured out, and like a lot of people, started noticing problems with my hands; had the little bump on the finger. We joked that it was the “ET” finger, had the little irritated joint at the end.

 

Fortunately, I've been pretty active. But, you know, it still is a learning process every step of the way. So, I'm so thankful that we've got the Arthritis Foundation to be a fantastic resource, and people can turn to it for every possible joint question they have. Which brings us to our topic today. We have 27 bones/joints, 34 muscles and over 100 ligaments and tendons in our hands. And then there's the whole blood vessels. It is just a complex thing, and we use them so often. In fact, humans: We're known for the dexterity in our hands; it’s one of our greatest tools. But alas, arthritis has its way with our hands quite often.

 

So, in this episode of the Live Yes! With Arthritis podcast, we’re going to discuss how those hand-related conditions affect the hand and how we can manage it. We'll discuss self-management techniques, treatments and all kinds of things associated with that. I'm joined today by Dr. Jeanine Beasley, occupational therapist, certified hand therapist, fellow of the American Occupational Therapy Association and professor at Grand Valley State University's occupational science and therapy department. Welcome.

 

Dr. Jeanine Beasley:

Thank you. It's really an honor to be here. And I want to thank the Arthritis Foundation, not only for this topic, but for all they do to help individuals with arthritis, including myself. And I have osteoarthritis of the hands, so… (laughs)

 

Trina Wilcox:

Yeah, tell me a little bit about your relationship with arthritis, your work with it and everything related to it.

 

Dr. Jeanine Beasley:

Well, although I'm a professor now, I started out working as a hand therapist for decades. I got my introduction to arthritis from Dr. Alfred Swanson. He was a surgeon who developed the artificial finger joints for the hand that are the gold standards throughout the world that are used for joint replacements. And so, I saw so many individuals with arthritis. They would fly into little Grand Rapids, Michigan, from all over the world. When you have it yourself, it's a passion to find the best treatments, to find the best interventions and also to share those with others.

 

Trina Wilcox:

Yeah. Because you definitely want to keep doing the activities that you like doing. And then just to function daily, you know, getting dressed, buttoning shirts, that's a big one. And so, it's nice to be able to have all the help we can on our side when it comes to those things.

 

Dr. Jeanine Beasley:

The internet is there, but sometimes the information needs to be filtered a little bit.

 

Trina Wilcox:

Yes.

 

Dr. Jeanine Beasley:

The Arthritis Foundation really helps to filter through some of the things to help us find the truths and the evidence.

 

Trina Wilcox:

You're really right. With your experience, what are some of the common types of arthritis that affect the hands and some of the conditions? You know, like carpal tunnel is a common one we all hear about.

 

Dr. Jeanine Beasley:

I’m sure there are different types of that even within itself. You and I represent two of the largest areas: rheumatoid and then osteoarthritis. Now with rheumatoid arthritis, you were diagnosed younger. So, it's good to know, “OK, I’ve got rheumatoid arthritis. There's going to be a tendency for my fingers to want to deviate to the side. I might not have it now. I might be well-managed with some of those wonderful biologics that we have.” But remember, they're not a cure. Occupational therapy, hand therapy and hand surgery can help.

 

With osteoarthritis, the thumb is just a big one. And as you pinch sometimes the thumb, you think, “Oh, my thumb is weak.” But actually, the bones are kind of losing their stability. It’s like the scaffolding just kind of “whoops,” you know? (laughs)

 

Trina Wilcox:

Yeah.

 

Dr. Jeanine Beasley:

Even though the muscles might be great, the bones are just kind of collapsing.

And so, there's things that can be done to… with a little splint, with surgery, with joint protection, things like that, that can really help with that. Psoriatic arthritis is another common one. And that is sometimes, as you know, hard to diagnose. People take a long time to figure out what's going on there.

 

There are certain markers with each one of these types of arthritis: the end joints with osteoarthritis, the metacarpal joints or the knuckles with rheumatoid arthritis, and with psoriatic arthritis, it can be the fingernails start to show those issues. And the fingers kind of get swollen. They call it like a little sausage kind of… sausage finger. And you'll get ridges or dents or sometimes pits in those fingernails. So, if those are things that you're seeing, and you have joint pain… Sometimes people say, “I have got psoriasis,” but you may also have psoriatic arthritis.

 

You mentioned carpal tunnel syndrome. And it's like, what does that have to do with this?  And people say, you know, anything with the hand is carpal tunnel, but it's not the case. You need to have numbness and tingling in your hand, because that means the nerve that goes to that hand is being squished.

 

Kind of like, oh, I was watering my flowers, and my daughter came up and drove her car right on top of my garden hose. You see, my garden hose was squished, so the nerve to the hand can be squished. And then I didn't get any water out the end of my hose. Or you don't get any electrical impulses to your fingers. That's really what carpal tunnel is, and it's caused by synovitis around that area, increased pressure to the wrist because of extra stuff in there. Or actually, a little bit of joint positioning sometimes. So, that can happen with carpal tunnel. So, you can have joints and nerves involved in that condition.

 

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Trina Wilcox:

I've actually talked to a few people that they kind of start noticing some of that… either osteo or possibly even rheumatoid, because their hands are achy and things like that. What are some notes they should be taking to know when to go to the doctor?

 

Dr. Jeanine Beasley:

We have a real shortage of rheumatologists in this country, I feel, especially pediatric rheumatologists.

 

Trina Wilcox:

Yes.

 

Dr. Jeanine Beasley:

I would start with your general doctor and say, "You know, I'm wondering if what this really is…" And if your general practitioner is saying, "Well, it might be rheumatoid arthritis, it might be osteoarthritis, might be another form." They are the ones to help you get that referral to the rheumatologist. And it may take a few weeks or longer to get in to see that rheumatologist. So, my thought is not to wait. If you're starting to notice some angulation of your fingers, especially towards your little finger of your hand…

 

I think it's always best to get to that rheumatologist. And, hey, you find out: Nope, you're good; or you got the answers you need, you know. Another option, though, is also asking your general doctor to have you see a hand therapist as well. And they can help you to navigate. They could help you with, “Oh, these are things you can do at home to protect your joints. This is a splint that might be helpful to you at nighttime, just to give you some stability.” Maybe talk to a surgeon, talk to an occupational therapist that specializes in hand therapy. And getting that referral from your general doctor or rheumatologist can really be a nice, intermediate step.

 

Trina Wilcox:

What were some of the challenges that you have gone through with all of this manifesting?

 

Dr. Jeanine Beasley:

Pain is our (laughs) “Hello!” Hello, pain!

 

Trina Wilcox:

Hello, pain.

 

Dr. Jeanine Beasley:

You just can't believe it. My middle joint on my ring finger or my end joints: These are called the distal interphalangeal joints, or DIPS; and PIPS, the proximal interphalangeal joints. Now, I've done so much research, I'm like, "Oh, OK, I know that that joint is giving me some trouble. I'm going to put it in a little splint at night." And it really seems to help that pain.

 

There are other things you can do. The research is very supportive with osteoarthritis for heat, which can be a little paraffin bath that you get. Another thing is balneotherapy, which is natural mineral water, which has been shown to be very supportive.

 

I'm not going to talk about food. I'm not a dietitian, so I don't want to talk about putting anything within this. But in Europe, you know, they have these baths, these mineral baths that people go to. And I was like, "Oh, what's all this all about?" And then I read the research on it, and I was surprised how strong it was for mineral baths, like the Dead Sea in Israel that has been found to be very helpful. (laughs) So let's all get on a plane and go to Europe.

 

Trina Wilcox:

Yeah. I'm for it. Let's do it.

 

Dr. Jeanine Beasley:

I personally, though, have found that with that pain, a little splint or orthosis is helpful. Also, respecting that pain. If it hurts, I should change the way I'm doing something so I can keep doing it. Opening those jars, opening those creamers, oh my gosh. Those little creamers. Yeah. Awful. Then there's butter. You know, like, hello.

 

Trina Wilcox:

Oh, my goodness.

 

Dr. Jeanine Beasley:

The Arthritis Foundation has the Ease of Use products that they've really researched and are on their website that you can say, "Hey, this is one that might help me in that area."

 

Trina Wilcox:

Yeah. Nothing's worse than getting defeated by a package that arrived in the mail. And you're so excited, but you can't get into it. (laughter)

 

Dr. Jeanine Beasley

Can't get into, I know.

 

Trina Wilcox:

I keep scissors close by at all times.

 

Dr. Jeanine Beasley:

Yes. Yes. And it actually protects your joints, you know?

 

Trina Wilcox:

It does.

 

Dr. Jeanine Beasley:

There are some scissors that have loops on them so that they automatically open. Have you've seen those?

 

Trina Wilcox:

I have not seen those.

 

Dr. Jeanine Beasley:

They spring open and close, and it makes it a little bit easier to open that package from Amazon that's on your doorstep with the thing you really need to use that day, so… (laughs)

 

Trina Wilcox:

With your orthopedic shoes in there.

 

Dr. Jeanine Beasley:

Absolutely. When you're the therapist, you know, you've got all these great ideas now. When I'm the patient, I'm like, sometimes we don't listen to our own best advice. It's like, “I’m just going to do it, and I'm going to force through it." And then, you know, we have pain that lasts a long time.

 

Trina Wilcox:

For sure.

 

Dr. Jeanine Beasley:

There are exercises that you can do to maintain your range of motion or even slightly increase it. But it all should be done in that pain-free range. We have pain for a reason. If we go beyond the pain every day, the pain stays. If we stay in that pain-free range, well, hello. We're going to be able to increase the amount of motion that we have without pain. It's quite lovely.

 

Trina Wilcox:

How important is it, no matter what stage of your diagnosis you're in, that we do exercises with our hands and like the whole putty thing or, you know, stretching? Should we be doing that on a regular basis?

 

Dr. Jeanine Beasley:

It's not one-size-fits all for exercise. Like, for example, if you are squeezing putty and your fingers are going into ulnar deviation or toward the… the bad way… then that's not helping. We want to exercise in a way that keeps the fingers lined up. You see what I mean?

 

Trina Wilcox:

Right.

 

Dr. Jeanine Beasley:

A hand therapist can set you up for exercises that there's so much wonderful research now that says, for example, “Strengthening this little muscle in your hand that makes your finger go sideways has been shown to really decrease thumb issues.” Taking a little rubber band and spreading it is really helpful for osteoarthritis. And the thumb pain that comes with that. But it may not be wonderful for some other times.

 

Doing pain-free movement every day is helpful. So helpful. Like getting in warm water or, you know, getting in a warm pool. I've got all these studies, they measure people's… how strong their grip strength is. And if you have an overall kind of fitness, your grip strength goes up, even if you weren't working on grip strength of the hand.

 

Trina Wilcox:

Wow.

 

Dr. Jeanine Beasley:

So, it's a real indicator of not only fitness, but wellness. A hand therapist can help you say, "Hey, what is my grip strength, and how does it compare to others?" And you know what? That's going to get me in the pool in a pain-free way on a regular basis. (laughs)

 

Trina Wilcox:

It does seem like one day you're fine, and then you wake up one day, and it's like, when did this happen?

 

Dr. Jeanine Beasley:

I know.

 

Trina Wilcox:

It's just so incremental, tiny incremental changes. And the next thing you know, you can't open the jar or whatever you like to do.

 

Dr. Jeanine Beasley:

So true. But also remember it ebbs and flows, doesn't it?

 

Trina Wilcox:

Yeah.

 

Dr. Jeanine Beasley:

It's like, today I can open that. Tomorrow, I can't. But oh, now, today I can again. We have daily ups and downs that need to be respected. Nighttime can really be the time to maintain, for example, getting a nice posture when we sleep, and then sometimes splints for the hands can be really helpful. Use those several hours of sleep. Of course, a lot of us don't get enough sleep, let me tell you.

 

Trina Wilcox:

Right.

 

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Trina Wilcox:

At some point, a lot of us face surgery. And so, that can be very emotional and overwhelming. What kind of impact do you see it having on patients today and maybe five or 10 years from now?

 

Dr. Jeanine Beasley:

Well, let's just briefly talk about total knees, total hips: The quality of life really seems to go up after those surgeries, and people hesitate a long time to have those total knees and total hips. With the hands, now since we've had the biologics for so long, there's less surgeons that know how to do those hand surgeries.

 

I think what you do is: You go to the surgeon, and you get the data. You go there and you say, "OK, what surgery do you recommend for me? What are the outcomes?" And then think about it. Think about it.

 

Trina Wilcox:

Yeah.

 

Dr. Jeanine Beasley:

It's like, OK, is this a good time? What kind of outcomes? There can be just wonderful outcomes with some of these surgeries, so I wouldn't hesitate. But it's a relationship that you need to talk over with your surgeon and say, “You know, I think I’m going to put it off a year.” Or, “I shouldn't put it off a year.”

 

Trina Wilcox:

I had a right wrist fusion in college. And then just in December, I had synovectomy with allograft, basically allograft tendon replacement. And it was scary, you know? I mean, my fingers had collapsed. I couldn't use them. So, I really didn't have time to decide. But thankfully, I had a good surgeon that knew what she was doing and got me up and running. But I was nervous about if I'd be able to function as well as I did before. And thankfully, I'm at that point. But sometimes you have to weigh options, and that's very hard to know what's going to be best.

 

I am not ready to fuse any fingers. And I'm very frustrated that the joint replacements are not where I need them to be. The longevity is not there yet for most of the size that I would need in my hands. And I'm trying to wait and see what happens. So, that's frustrating.

 

Dr. Jeanine Beasley:

So, you probably had to be immobilized in some kind of splinter cast for several weeks.

 

Trina Wilcox:

Two weeks with the giant one, but then the splint for a couple of weeks, and I really anticipated the bulky one for the duration of healing, but it was not that case at all. So, I didn't have to cut up all my clothes. (laughter) So, it wasn't as frightening as I thought. I thought I wasn't going to be able to use my arm at all. But it was a big process.

 

Dr. Jeanine Beasley:

Yes. I love that you brought up adapting your clothes to fit over that, because people don't think about that. They go into surgery, and then it's time to go home. And it's like, what am I wearing? I have no idea.

 

Trina Wilcox:

If you're a tendon organ donor, it makes people like me able to function again. So, thank you. Please consider that. It's a very important thing that people don't always think about. They always think bigger things: heart, lung… But tissue is so important and can make somebody's life 100 times better.

 

Dr. Jeanine Beasley:

That is great.

 

Trina Wilcox:

Yeah. You had mentioned earlier about getting frustrated, and that's something that I want to bring up: the emotional impact of, you know, having difficult functionality with your hands, and usually you're in pain somewhere else. Let's be real. How has that been for you or anyone else you've talked to? And how did they get through it?

 

Dr. Jeanine Beasley:

The pain is… it seems to have its time. And then it goes away. “No, not painful anymore. You know, it was, but it isn’t anymore.” We have all this technology, all this stuff, that we can change the way that we do things and keep doing those things. Like keyboarding. I went through college without a computer, but now how could I be without it? If keyboarding becomes difficult, we've got voice to text.

 

Trina Wilcox:

At my desk, I always use my keyboard. But on the phone, sometimes I will get tired of trying to make my fingers work. So, I use the voice features for sure.

 

Dr. Jeanine Beasley:

That is a wonderful example of balancing rest and activities. Which is, again, a joint protection principle. There are six areas of joint protection and how they fit into your life.

I've learned a lot from my European friends about what really good joint protection principles are. But it's really what it's all about with the hand.

 

Trina Wilcox:

It's something everybody can benefit from, for sure.

 

Dr. Jeanine Beasley:

Yes.

 

Trina Wilcox:

And we touched on it a little bit about, you know, the biologics for RA. What are some of the things, though, for pain management that people might not think about?

 

Dr. Jeanine Beasley:

I don't want to talk about medications or food because that's outside of my scope. But, I have done research with arthritis and systematic reviews that have demonstrated the advantages of heat are very helpful. Paraffin for those with rheumatoid arthritis has strong support in the literature. You can get pumpkin-scented paraffin.

 

Trina Wilcox:

It’s a wax. You melt it down, and you just immerse, and it is a warm sensation. It kind of firms up. And then you kind of just peel it off, right?

 

Dr. Jeanine Beasley:

Right. If you can make your own with paraffin and mineral oil, you want to be sure you have the right temperature. You could burn yourself if it's too hot. And then you dip your hand.

 

Do about 10 dips and then, putting a plastic bag over it, and then a towel. If you're having trouble with closing your hand, then I would recommend that you have the paraffin on and close your hand, and that's going to actually increase your ability to close your hand. If you're having trouble opening your hand, then I would do it in an open position, gentle, because the combination of gentle positioning and heat is better than just the heat or just the exercise. The two work together.

 

A heating pad, very helpful. And there's electrical modalities that are very helpful. TENS, transcutaneous electrical nerve stimulation. You can get those at your pharmacy now. There are little electrical patches that you put on, whether it's your hand or other parts of your body. And the research is incredibly supportive, especially with rheumatoid arthritis, for decreasing pain. Instead of taking maybe a pain pill, you would put this electricity on your hand called TENS. It's very inexpensive and very helpful.

 

Trina Wilcox:

Do you have any other key takeaways we haven't thought to cover yet that people can benefit from?

 

Dr. Jeanine Beasley:

First of all, I think I would get the help of a hand therapist. If you get an order, an order for a hand therapist, from your general doctor or your rheumatologist. Think about using heat in a safe, comfortable way, and to really balance your work and activity. Respecting your pain. Following the principles of joint protection, protecting your joints.

 

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Trina Wilcox:

Before each episode, we post a question on social media. And asked: What’s the biggest impact arthritis has had on your hands and how do you deal with it? And got some great responses. Gavin Moon said, "I swear at small objects that require a lot of finger dexterity." And sadly, I think we all can kind of relate to that. "It's really awkward when you're swearing at a button in a bathroom stall, and then you walk out and realize someone else is there." (laughs)

 

Dr. Jeanine Beasley:

Now, for that one, there is a button hook. I don't know, have you seen the button hook?

 

Trina Wilcox:

I've seen these, but I've not had one. I think I need one in my kit, because buttons have been a nemesis for sure.

 

Dr. Jeanine Beasley:

Actually, it has a history. Remember when there were buttoned shoes, you know? They would use this little… It's a tool that has just a little wire on it, and it actually grabs the button through the buttonhole, pulls it through. So, it's a tool that's very helpful, very inexpensive. You can make them out of a paperclip.

 

Trina Wilcox:

There you go. It's going on my Christmas list. We had another, first-time mom recently had a flare. “I was unable to pick up my baby from his crib. It was so heartbreaking to ask for help. I just wanted to cuddle him.” That is so heartbreaking, when you just want to care for someone else and you're having trouble yourself. I think we can all relate to that, too.

 

Dr. Jeanine Beasley:

Yes, I think with a new mom and a baby. And I'm hoping that she has less pain going forward. But, modifying how she picks up that baby, the level of the crib so she doesn't have to reach down so far low. But if the baby is standing, then you’ve got to go low. But if the baby is not, is much younger, you can have the crib a little bit higher; the baby can be safe. And then if you can get a crib where the railing goes down, so that you can slide the baby towards you comfortably, there's a way to lift the baby appropriately with your hands, and also using your legs.

 

Trina Wilcox:

Karen K. Peters said, “I can't even put on earrings, and I had to remove my wedding ring due to swollen misshapen joints. Any advice for wedding ring?”

 

Dr. Jeanine Beasley:

I saw that there are some wonderful little latches. They open up and close around and enlarge. This is called your PIP joint. They're kind of expensive, but you know, Christmas is coming. Hello. It's called kind of an arthritic hinge. And jewelers can put those on.

 

Earrings are hard because of the tiny backs to them. Now, do you remember the clip-on earrings that were a lot easier to put on? There are also magnetic earrings.

 

Trina Wilcox:

I have used them. It depends on what day it is and how my fingers are behaving. Thank you for this conversation. This has been wonderful. Do you have takeaways from the episode?

 

Dr. Jeanine Beasley:

Well, yeah. I hope that the people listening to this realize that, “Hey, I’ve got to really figure out my specific issue and not read about something that doesn't apply to me,” you know what I'm saying?

 

Trina Wilcox:

Right. I think a few of my takeaways would be definitely: preventative care. Try to take care and protect those joints. Have a good relationship with your doctor and your hand surgeon for sure. And cut yourself some slack. Sometimes, you just have to ask for some help.

 

Dr. Jeanine Beasley:

It's OK.

 

Trina Wilcox:

It's OK. Thank you so much. We appreciate you tuning in and listening to this episode. You can always find more information, resources, and connect to your closest chapter at arthritis.org. Thanks so much.

 

Dr. Jeanine Beasley:

Thank you. It's been a pleasure.

 

PODCAST CLOSING:

This episode of the Live Yes! With Arthritis podcast was brought to you in part by Aleve and by Amgen.

 

The Live Yes! With Arthritis podcast is independently produced by the Arthritis Foundation. Gifts from people like you make our podcast and other life-changing resources possible. You can donate at arthritis.org/donate. This podcast aims to help people living with arthritis and chronic pain live their best life. For a transcript and show notes, go to arthritis.org/podcast. Subscribe, rate and review us wherever you get your podcasts. If you subscribe through Spotify, leave a comment on their platform, letting us know what you think about this episode. And stay in touch!